Client Satisfaction Form 2024

Client Satisfaction Form 2024
We look forward to hearing your feedback regarding our services! We use the responses to improve the experience of our clients, their families, and other community members we work with. In addition to filling out the form below, please do not hesitate to call our office at 410-780-5203 if there is a specific issue or concern you would like to discuss.
Who is the identified client? If more than one family member is a client, feel free to fill out a survey in regards to each client's experience at Thrive.

I am a clientI am the guardian of a client
If you would like a copy of this survey sent to you please enter your email below.
example@example.com
Thrive Office Location

RosedaleMillersvilleCatonsvilleSilver Spring
Therapy Services Feedback
What is the name of the client's therapist?
The therapist sees me/ my child at:

hometelehealthschoolofficeOther
If your child is being seen in school, please list the school below.
How long have you been receiving services from Thrive?

1-6 months6-12 months1-3 years3-5 years5 years or more
The therapist meets with me/my child regularly.

Strongly agreeAgreeDisagreeStrongly disagreeOther
The therapist involves me in my/ my child's treatment planning, including treatment goals and needs.

Strongly agreeAgreeDisagreeStrongly disagreeOther
The therapist asks at least every 6 months about progress towards goals and whether needs were met.

Strongly agreeAgreeDisagreeStrongly disagreeN/A- have not been a client for 6 monthsOther
The therapist methods, approach, and interventions are good fit for me/ my child.

Strongly agreeAgreeDisagreeStrongly disagreeOther
I feel the therapist works to actively support and understand me/my child.

Strongly agreeAgreeDisagreeStrongly disagreeOther
The therapist has made me aware of the missed appointment, attendance and discharge policy?

YesNoOther
Medication/Psychiatric Services Feedback
What is the name of the client's prescriber? Type N/A if you do not see a prescriber at Thrive.
The prescriber is approachable regarding my questions/ concerns.

Strongly agreeAgreeDisagreeStrongly disagreeN/AOther
The prescriber provides me information about side effects of medications.

Strongly agreeAgreeDisagreeStrongly disagreeN/AOther
I feel comfortable talking about my/ my child's problems with the prescriber.

Strongly agreeAgreeDisagreeStrongly disagreeN/AOther
Do you feel there is enough time during your/ your child's appointment to discuss medication?

Always enough time/Never feel rushedSometimes enough time/Sometimes feel rushedRarely feel rushed/Usually enough timeNever enough time/Feel rushed
Office and Overall Feedback
The administrative staff (front desk) are professional, courteous, and welcoming.

Strongly agreeAgreeDisagreeStrongly disagreeN/AOther
The drivers/ van service are safe, professional, and courteous.

Strongly agreeAgreeDisagreeStrongly disagreeN/AOther
I (and/ or my child) feel welcomed by staff at Thrive.

Strongly agreeAgreeDisagreeStrongly disagreeOther
Have you been treated differently or experienced discrimination based on your race, ethnicity, religion, gender, sexuality, or other aspects of your cultural identity by any Thrive staff? If so, please share about your experience. Thrive is committed to anti-racism and does not tolerate discrimination.
Overall, there is progress being made toward treatment goals.

Too early to tellStrongly AgreeAgreeDisagreeStrongly Disagree

Overall, what grade would you give Thrive?

	1	2	3	4	5

1 is Worst, 5 is Best

I would recommend Thrive to a family member or friend.

YesNo
Please use the additional space to list any comments, suggestions, or concerns. Do you have feedback on how we can improve quality, safety of care, treatment, or services provided?
I give permission to Thrive to use my comments above in public communications such as the website. My name would not be listed. The purpose would be to help others have hope that help is out there.

YesNo
If you would like a call regarding your responses, please provide your phone number:

Area CodePhone Number
Name if you would like a call back:

First NameLast Name
Thank you very much for taking the time to complete this survey. Your feedback is valued and very much appreciated!
Should be Empty:

Client Satisfaction Form 2024

Therapy Services Feedback

Medication/Psychiatric Services Feedback

Office and Overall Feedback

Thank you very much for taking the time to complete this survey. Your feedback is valued and very much appreciated!